Miyamoto Yosuke, Kawasaki Takashi, Nakamura Shingo, Hirata Naoyuki
Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
JA Clin Rep. 2024 Aug 20;10(1):51. doi: 10.1186/s40981-024-00736-x.
Dysfunction of ventriculoperitoneal (VP) shunts can lead to decreased levels of consciousness. We report a case of delayed emergence from anesthesia due to the malfunction of a VP shunt during neurosurgery in the prone position.
A 75-year-old male with a history of VP shunt for a fourth ventricle obstruction underwent cerebral vascular anastomosis in the prone position. His preoperative level of consciousness was clear. The surgery under general anesthesia was completed without any particular issues. After discontinuation of anesthesia, the patient did not awaken for over an hour. Postoperative CT revealed exacerbated hydrocephalus, likely from VP shunt occlusion. After pumping the reservoir of the VP shunt, the patient regained consciousness. He was extubated and discharged from ICU on the second postoperative day with no neurological issues.
For surgical patients with a VP shunt, anesthesia management must consider the risk of shunt malfunction due to patient positioning.
脑室腹腔（VP）分流器功能障碍可导致意识水平下降。我们报告一例在俯卧位神经外科手术期间因VP分流器故障导致麻醉苏醒延迟的病例。
一名75岁男性，有因第四脑室梗阻行VP分流术的病史，在俯卧位下行脑血管吻合术。其术前意识水平清醒。全身麻醉下的手术顺利完成，无任何特殊情况。麻醉停止后，患者一个多小时未苏醒。术后CT显示脑积水加重，可能是由于VP分流器堵塞。在按压VP分流器的储液囊后，患者恢复意识。他于术后第二天拔除气管插管并从重症监护病房出院，无神经功能问题。
对于有VP分流器的手术患者，麻醉管理必须考虑因患者体位导致分流器故障的风险。
